Health inequalities affect the health of all

Abstract

> ‘We must never forget: evidence has great strategic and persuasive power at the policy level.’ ( Director-General of the World Health Organization, 2007 ) The runaway publishing success of The Spirit Level by Wilkinson and Pickett has put health inequalities on everyone's lips.1,2 Using the evidence, based on decades of research, they remind us that the causes of most health inequalities in developed countries are rooted in the structure of society and particularly in income inequalities. Using data from 23 of the richest countries, and a separate analysis for the 50 states of North America, they illustrate the social gradient in life-expectancy, and physical health, along with other factors on the index of health and social problems, such as educational performance, levels of trust within local communities, imprisonment rates, teenage births, and homicides. Every country and North American state has a social gradient for each of these factors. But the book's message is that the level of income inequalities within developed countries will determine where a country falls on the international gradient. Hence the UK, with high current levels of income inequality, will fall low on the international gradient for many of the societal factors that predict premature mortality and chronic ill health. Combining this international message with that from the recent Marmot Review of health inequalities in England makes for serious reflection. Marmot confirms the continuing mortality gradient of 7 …